Question 1

A pregnant woman has been receiving a magnesium sulphate infusion for treatment of severe pre-eclampsia for 24 hours.On assessment the nurse finds the following vital signs: temperature of 37.3° C,pulse rate of 88 beats/min,respiratory rate of 10 breaths/min,blood pressure (BP)of 148/90 mm Hg,absent deep tendon reflexes,and no ankle clonus.The patient complains,"I'm so thirsty and warm." What is the nurse's initial intervention?

Accepted Answer

The patient is displaying clinical signs and symptoms of magnesium toxicity.Magnesium should be discontinued immediately.In addition,calcium gluconate,the antidote for magnesium,may be administered.Hydralazine is an antihypertensive commonly used to treat hypertension in severe pre-eclampsia.Typically it is administered for a systolic BP over 160 mm Hg or a diastolic BP over 110 mm Hg.

Question 2

Which laboratory result is indicative of disseminated intravascular coagulation (DIC)?

Accepted Answer

Decreased fibrinogen is seen with DIC.With DIC,platelets are decreased,factor V is decreased,and fibrin degradation fragment is increased.

Question 3

Which finding is of concern in a primigravida that is being monitored in the prenatal clinic for pre-eclampsia?

Accepted Answer

Proteinuria is defined as a concentration of ³30 mg/mmol in a random urine specimen and should alert the nurse that additional testing or assessment should be made.Generally,hypertension is defined as a BP of 140/90.Pre-eclampsia may manifest as a rapid weight gain of more than 2 kg in 1 week.Edema occurs in many normal pregnancies and in women with pre-eclampsia.Therefore,the presence of edema is no longer considered diagnostic of pre-eclampsia.

Question 4

A woman with severe pre-eclampsia has been receiving magnesium sulphate by intravenous infusion for 8 hours.The nurse assesses the woman and documents the following findings: temperature of 37.1° C,pulse rate of 96 beats/min,respiratory rate of 24 breaths/min,blood pressure (BP)of 155/112 mm Hg,3+ deep tendon reflexes,and no ankle clonus.Which medication should the nurse anticipate will be ordered for this patient?

Accepted Answer

Hydralazine is an antihypertensive commonly used to treat hypertension in severe pre-eclampsia.Typically it is administered for a systolic BP over 160 mm Hg or a diastolic BP over 110 mm Hg.An additional bolus of magnesium sulphate may be ordered for increasing signs of central nervous system irritability related to severe pre-eclampsia (e.g. ,clonus)or if eclampsia develops.Diazepam sometimes is used to stop or shorten eclamptic seizures.Calcium gluconate is used as the antidote for magnesium sulphate toxicity.The patient is not currently displaying any signs or symptoms of magnesium toxicity.

Question 5

Which is true about women who experience hyperemesis gravidarum?

Accepted Answer

Women with hyperemesis gravidarum have severe vomiting;however,treatment for several days sets things right in most cases.Although 70% of pregnant women experience nausea and vomiting,about 0.5 to 2% proceed to this severe level.IV administration may be used at first to restore fluid levels,but it is seldom needed for very long.Women suffering from this condition want sympathy,because some authorities believe that difficult relationships with mothers or partners may be the cause.

Question 6

Which should the nurse be concerned about when caring for a woman with severe pre-eclampsia who is receiving a magnesium sulphate infusion?

Accepted Answer

A respiratory rate of 10 breaths/min indicates that the patient is experiencing respiratory depression from magnesium toxicity.Because magnesium sulphate is a central nervous system depressant,the patient will most likely become sedated when the infusion is initiated.Deep tendon reflexes of 2 and absent ankle clonus are normal findings.

Question 7

What should the nurse be aware of in relation to women who may need surgery during pregnancy?

Accepted Answer

Both appendicitis and pregnancy are linked with nausea,vomiting,and increased white blood cell count.Rupture of the appendix is two to three times more likely in pregnant women.Surgery to remove obstructions should be done right away.It usually does not affect the pregnancy.Pregnancy predisposes a woman to ovarian problems.

Question 8

Which is correct when providing follow-up management for a woman who had a hydatidiform mole?

Accepted Answer

Follow-up management includes frequent physical and pelvic examinations along with measurement of serum ?-hCG until the level drops to normal and remains normal for 3 weeks.Monthly measurements are taken for 6 months.Follow-up assessment period usually continues for 1 year,not 2 years.

Question 9

What should the nurse be aware of when planning care for women with pre-eclampsia?

Accepted Answer

Induction of labour is likely,as near term as possible;however,at less than 37 weeks of gestation,immediate delivery may not be in the best interest of the fetus.Strict bedrest is becoming controversial for mild cases;some women in the hospital are even allowed to move around.Diet and fluid recommendations are much the same as those for healthy pregnant women,although some authorities have suggested a diet high in protein.Women with severe pre-eclampsia should expect a Caesarean delivery.

Question 10

Which is true in relation to HELLP syndrome?

Accepted Answer

The acronym HELLP stands for hemolysis (H),elevated liver enzymes (EL),and low platelets (LP).HELLP syndrome is a variant of severe pre-eclampsia.HELLP syndrome is difficult to identify because the symptoms often are not obvious.It must be diagnosed in the laboratory.Preterm labour is greatly increased and so is perinatal mortality.

Question 11

A woman with pre-eclampsia has a seizure.What is the nurse's priority intervention?

Accepted Answer

If a patient becomes eclamptic,the priority intervention is to ensure a patent airway.The nurse should attempt to keep the airway patent by turning the patient's head to the side to prevent aspiration.The nurse should stay with her and call for help,not to provide emotional support.Once the seizure has ended,it may be necessary to suction the patient's mouth.Oxygen would be administered after the convulsion has ended.

Question 12

In caring for the woman with disseminated intravascular coagulation (DIC),which order should the nurse anticipate?

Accepted Answer

Primary medical management in all cases of DIC involves correction of the underlying cause,volume replacement,blood component therapy,optimization of oxygenation and perfusion status,and continued reassessment of laboratory parameters.Central monitoring would not be ordered initially in a patient with DIC because this can contribute to more areas of bleeding.Management of DIC would include volume replacement,not volume restriction.Steroids are not indicated for the management of DIC.

Question 13

A woman at 39 weeks of gestation with a history of pre-eclampsia is admitted to the labour and birth unit.She suddenly experiences increased contraction frequency of every 1 to 2 minutes;dark red vaginal bleeding;and a tense,painful abdomen.The nurse suspects the onset of which condition?

Accepted Answer

Uterine tenderness in the presence of increasing tone may be the earliest finding of premature separation of the placenta (abruptio placentae or placental abruption).Women with hypertension are at increased risk for an abruption.Eclamptic seizures are evidenced by the presence of generalized tonic-clonic convulsions.Uterine rupture presents as hypotonic uterine activity,signs of hypovolemia,and in many cases the absence of pain.Placenta previa presents with bright red,painless vaginal bleeding.

Question 14

The labour of a pregnant woman with pre-eclampsia is going to be induced.Before initiating the oxytocin infusion,the nurse reviews the woman's latest laboratory test findings,which reveal a platelet count of 96 x 10?/L,an elevated aspartate transaminase (AST)level,and a falling hematocrit.What are these findings indicative of?

Accepted Answer

HELLP syndrome is a laboratory diagnosis for a variant of severe pre-eclampsia that involves hepatic dysfunction characterized by hemolysis (H),elevated liver enzymes (EL),and low platelets (LP).Eclampsia is determined by the presence of seizures.DIC is a potential complication associated with HELLP syndrome.Idiopathic thrombocytopenia is the presence of low platelets of unknown cause and is not associated with pre-eclampsia.

Question 15

Which statement is true of pre-existing hypertension?

Accepted Answer

Pre-existing hypertension is present before pregnancy or diagnosed before 20 weeks of gestation and persists longer than 6 weeks postpartum.It can occur with pre-eclampsia as well as other comorbid conditions.The range for hypertension is systolic BP greater than 140 mm Hg or diastolic BP greater than 90 mm Hg.It becomes severe with a diastolic BP of 110 mm Hg or higher.Proteinuria is an excessive concentration of protein in the urine.It is a complication of hypertension,not a defining characteristic.

Question 16

What is the most common medical complication of pregnancy?

Accepted Answer

Pre-eclampsia and eclampsia are two noted forms of hypertensive disorders in pregnancy and are the leading cause of maternal and perinatal morbidity and mortality.A large percentage of pregnant women have nausea and vomiting,but relatively few have the severe form called hyperemesis gravidarum.Hemorrhagic complications are the second most common medical complication of pregnancy;hypertension is the most common.

Question 17

What is the classification of placenta previa when the placental edge is 2.0 cm from the internal cervical os?

Accepted Answer

In a marginal placenta previa,the edge of the placenta is seen on transvaginal ultrasound as 2.5 cm or closer to the internal cervical os,whereas with a complete placenta previa,the placenta covers the internal cervical os totally.Class is not a classification of placenta previa but is used to classify placental abruption.

Question 18

A patient has been on magnesium sulphate for 20 hours for treatment of pre-eclampsia.She just delivered a viable infant girl 30 minutes ago.What uterine findings would the nurse expect to assess in this patient?

Accepted Answer

Because of the tocolytic effects of magnesium sulphate,this patient most likely would have a boggy uterus with increased amounts of bleeding and a heavy lochia flow in the postpartum period.

Question 19

What is the purpose of administering magnesium sulphate to women with pre-eclampsia and eclampsia?

Accepted Answer

Magnesium sulphate is the drug of choice to prevent convulsions,although it can generate other problems.Loss of patellar reflexes and respiratory depression are signs of magnesium toxicity.Magnesium sulphate can increase the duration of labour.Women are at risk for a boggy uterus and heavy lochial flow as a result of magnesium sulphate therapy.

Question 20

In caring for an immediate postpartum patient,the nurse notes petechiae and oozing from her IV site.Based on this assessment,what clotting disorder would the nurse monitor this patient closely for?

Accepted Answer

The diagnosis of DIC is made according to clinical findings and laboratory markers.Physical examination reveals unusual bleeding.Petechiae may appear around a blood pressure cuff on the woman's arm.Excessive bleeding may occur from the site of a slight trauma such as venipuncture sites.These symptoms are not associated with AFE,nor is AFE a bleeding disorder.Hemorrhage occurs for a variety of reasons in the postpartum patient.These symptoms are associated with DIC.Hemorrhage would be a finding associated with DIC and is not a clotting disorder in and of itself.HELLP is not a clotting disorder,but it may contribute to the clotting disorder DIC.

Quiz 14: Pregnancy at Risk: Gestational Conditions

Which laboratory result is indicative of disseminated intravascular coagulation (DIC) ?